Seanad Éireann debate -
Thursday, 19 Nov 2009

Vol. 198 No. 6

Hospital Services.

Senator Donie Cassidy

I wish to share time with Senator Glynn. I thank the Cathaoirleach for permitting me to the raise this important matter. I welcome the Minister of State at the Department of the Environment, Heritage and Local Government, Deputy Michael Finneran, who ably served as a Member of this House.

I ask the Minister for Health and Children to comment on the reduction in the number of acute beds in Mullingar Regional Hospital and indicate her intentions with regard to rewarding the most efficient hospitals in the country in the context of annual case mix adjustments.

The status of Mullingar Regional Hospital is a major cause of concern to people in counties Longford and Westmeath, the staff and patients of the hospital and those who have worked diligently to make it one of the most efficient hospitals in the country in the context of the annual case mix adjustment. There are major concerns that the Health Service Executive is pursuing a policy to downgrade the status of this fine hospital. We have been informed that 41 acute beds are to be closed. I am horrified that the decision to close these beds was taken without discussions with the consultant physicians charged with the care of patients. Physicians, nurses and other staff are greatly concerned that the number of beds being closed is grossly excessive and disproportionate. This decision will cause them immense problems in providing an acceptable level of care to patients. I am appalled that the HSE failed to engage in discussions with hospital staff before making its decision.

We are entering the winter months when more, not fewer, acute beds are needed. It is beyond comprehension that the HSE plans to close 41 acute beds at such a critical time and in a hospital with regional status. This is extraordinary behaviour and I fear the measure is part of a covert plan to downgrade a great hospital. Mullingar Regional Hospital has been one of the top ranking, best performing hospitals in recent years. In 2008 it broke even in terms of expenditure. The staff of the hospital consistently achieve high standards of care and efficiency, a fact which the Minister for Health and Children and Health Service Executive have not acknowledged. Instead, when the hospital was due to receive €2 million because of its case mix efficiency, it received only €500,000. I want to know why money due to Mullingar Hospital was diverted elsewhere. I also want to know why the Minister and the HSE have failed to reward the hospital as promised.

The Minister for Health and Children stood in this House and gave a commitment that the hospitals which performed best would be rewarded. I call on her to stand by the commitment she gave here and for Mullingar Regional Hospital to be rewarded for being the most efficient hospital in Ireland and the second best hospital in terms of hygiene and cleanliness. The high standards and excellent work in the hospital are a credit to Trevor O'Callaghan and the administrative staff of the hospital

We are fortunate in Mullingar Regional Hospital to have a complement of consultant physicians including Professor Sean Murphy, and an excellent clinical director, Dr. Ron Charles, who, together with their respective teams, have set up a stroke unit and have a medical assessment unit which is admired by the midlands and treats more than 180 people per month. This unit is visited by the staff of hospitals from all over the country. Our consultants are also working hard to establish an intervention cardiology unit where services can be provided and stents inserted without patients having to travel to Dublin. Where is the recognition for this commitment and hard work?

The HSE's statement that 13 additional day beds are to be made available from Monday to Friday for elective procedures is absurd. These 13 beds will be of no practical use to patients requiring emergency admissions. As the population is increasing in midland areas and the hospital is adjacent to Dublin, and with the difficulties being experienced in counties Longford and Westmeath we should be increasing the number of acute beds.

As a former member of the health board, as was Senator Glynn, I and other colleagues including the Minister of State, Deputy Moloney, got a categoric assurance from the Department of Health and Children when Longford Hospital closed that Mullingar Regional Hospital's services and facilities would be sacrosanct and suitable for a hospital serving two counties. This was a commitment made to the people of County Longford and I want to put on the record it is a commitment which we have not forgotten.

I call on the Minister to urge the HSE management team and relevant bodies to enter talks with the physicians, nurses and administrative staff in the hospital and endeavour to reach agreement on an allocation of acute beds which would be safer, fairer and which would satisfy the growing needs of the wider community. I acknowledge the funding of €20 million which has been given by the Minister for Health and Children, Deputy Harney, for the shelled-out building which stood for 12 years, which included funding of €5 million for finishing and fitting out level O.

Senator Camillus Glynn

I fully support this Adjournment matter. I have spent more than 30 years in public life. During all that time I have been active in defending the hospital and urging the powers that be such as the health board, of which I was a member for 23 years and chairman for two years, and the Minister for Health and Children, to ensure Mullingar Regional Hospital received due recognition for the great services it provide.

It is a flagship hospital and one of the top three performing hospitals in the country. Recently, following many complaints I received from people in the hospital and those living in Mullingar and Longford, I met with Professor Drumm in my office in Leinster House. I urged him to come to Mullingar and meet the staff of the hospital, which he did. At that time I asked him why Mullingar Regional Hospital had an allocation of X amount of euro but other hospitals which are performing below the standard of Mullingar in terms of output have a greater allocation. His response was that the HSE wanted to bring the other hospitals to which I referred up to the standard of Mullingar and not bring it down to the standard of the other hospitals.

All of the beds in the old hospital which was vacated have been moved into the newly fitted-out phase 2B shell. Mullingar Regional Hospital had 220 beds and now has 199. Included in the 220 beds were 11 day beds. There are now 24 day beds. This is linked to the practice of treating people on a day patient basis.

I accept that Mullingar is not getting a fair crack of the whip. In the past number of months the dermatologist left and went further afield because she did not get the resources with which she should have been provided. I am pleased to inform the House there is now a temporary dermatologist in place who will be seeing current patients and a permanent post will be advertised shortly.

I agree with what my colleague said. I strongly endorse the great service provided by the physicians in the hospital, who are led by Professor Sean Murphy and Dr. Ron Charles, the clinical director, and by all the ancillary and back-up staff. It must be remembered there is a moratorium on the recruitment of public sector staff.

I wish to discuss the old hospital which has been vacated. It might be a good story. I strongly support Senator Cassidy and deplore the reduction of 21 beds and it should not have happened. A central staff changing area, a laundry and distribution area will be provided and an area to provide stock for a top-up system which will make the stock management more efficient in order to save money will be established in the old hospital. All of this relates to the non-pay sector.

Ward 1 will be used as a mass vaccination site for administering the swine flu vaccine for the foreseeable future. Ward 3 will be a diabetes day care centre to support the endocrinology service, a very important service. I was responsible for a debate in this House on the levels of type 1 and type 2 diabetes. Ward 4 will be used to develop women's health, with particular reference to foetal assessment, something which was looked for by Dr. Bates and other members of his team.

I am less than satisfied with the manner in which Mullingar Regional Hospital has been treated. It is a flagship hospital providing one of the top services in the country and performing at a level far above that of other hospitals which are receiving a greater allocation of money. It is important that the beds which have been removed are replaced. I accept we are in difficult times but Mullingar needs to be treated fairly and, in this case, it has not been.

Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Michael Finneran)

I thank the Leas-Chathaoirleach, the Leader of the House, Senator Cassidy and Senator Glynn. I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. The Midland Regional Hospital at Mullingar provides an extensive range of quality-driven acute services to the population of Dublin, the midlands and, in particular, to people in the Longford and Westmeath area.

I am pleased to say that the transfer of patients to the upgraded ward areas, which are part of phase 2B of the capital development at Mullingar, has been completed. The total bed complement now comprises 158 inpatient beds, 24 day beds, six medical assessment unit beds and 11 observation unit beds, giving a total of 199 beds overall. A key priority has been to move patients from the four old Nightingale wards in the 1930s building to the recently completed wards. These wards are a major improvement in terms of the standard of care which can be afforded to patients. The rationale behind the reconfiguration of inpatient beds to day beds involves encouraging a greater emphasis on the practice of day care medicine which forms part of the HSE's transformation programme. The reconfiguration of the bed complement in the new hospital which will include a significant increase in the number of day ward beds will reduce the cancellation of inpatient elective surgical work at the hospital. This will be done through the ring-fencing of day beds in the surgical ward for surgical procedures. The reconfiguration will also facilitate the treatment of gynaecology patients at the hospital on a day basis. The provision of additional day ward beds for such procedures will help to reduce the level of cancellation of inpatient gynaecology procedures at the hospital. The reconfiguration will also increase the availability of medical day ward procedures in areas such as cardiac intervention and colonoscopies. This will reduce the need for inpatient admissions to the hospital. The reconfiguration will also increase the throughput of the existing medical assessment unit which has received much favourable comment.

The revised bed complement has been fully endorsed by the consultant surgeons and obstetricians at the hospital. In addition, the focus for the hospital, by agreement with all relevant consultant staff, is to increase the throughput of surgical and gynaecology work at the hospital. The provision of additional day ward beds I have detailed will facilitate this increase in workload. This approach is in line with the proposals at national level to increase the usage of day beds in our acute hospitals. The current usage of day beds in Mullingar hospital is still behind the international norms for bed utilisation. The adjustment in beds taking place will help to improve the situation, thereby making the hospital even more effective in providing care and treatment in the future.

The increase in the provision of day beds will ensure the Midland Regional Hospital in Mullingar will treat more patients in 2010 than in 2009. It should be noted that inpatient activity in the hospital to the end of September was 0.2% ahead of last year, while day case activity had increased by 6.2% year on year. Hospital funding is linked with performance through the national Casemix programme which compares costs and activities across the 37 hospitals which participate in the Casemix budget model and reviews the allocation of over €4.5 billion in acute hospital funding. The programme continues to be developed and rolled out in new hospitals as well as hospitals which are already within the programme.

The budgetary allocation for the Midland Regional Hospital in Mullingar has increased significantly by 17.9% in the last four years, from €54.8 million in 2006 to €64.6 million in 2009. The hospital has been recognised as one of the most efficient in the country in the context of the annual Casemix adjustment. The increases I have mentioned include the positive Casemix adjustment figures in respect of each of the last two years. The extra money gained by the hospital was €2.01 million in 2008 and €1.9 million in 2009. I am confident the hospital will continue to provide the best possible quality of care for all its patients.

Senator Donie Cassidy

I thank the Minister of State for the comprehensive reply he has given to Senator Glynn and me. My understanding, on the basis of the information I have been given, is that the consultant staff have not been consulted.